Measuring the Need for Mental Health Care

Prologue: One of the toughest tasks facing mental health policymakers and providers is to determine the need for services. Three streams of research contribute to the search for policy solutions: epidemiology, which addresses the prevalence of mental illness; clinical research, which addresses the effectiveness of treatment; and mental health policy research, which deals with financial and organizational issues. The lead author of this paper, the late Gerald L. Klerman, was uniquely positioned to offer leadership in all three areas. His high standing in government and academia lent credibility to his strong insistence that scientific and policy questions should be viewed separately. Defining need for services is a policy question; defining prevalence, a scientific one. Policy should not be derived directly from science, he contended; rather, science should inform policymakers and aid their decisions. This paper looks at the need for services from an epidemiologic perspective, in the context of the high known prevalence of psychiatric conditions throughout the U.S. population. Before his death in April 1992, Klerman was professor of psychiatry and associate chairman for research at Cornell's Department of Psychiatry. He was administrator of the Alcohol, Drug Abuse, and Mental Health Administration during Jimmy Carter's presidency, before which he conducted and led psychiatric research at Harvard and Yale. Mark Olfson, currently an assistant professor of psychiatry at Cornell, received his medical degree from Northwestern University and trained in psychiatry at Yale. Andrew Leon is assistant professor of biostatistics in psychiatry at Cornell. Myrna Weissman is professor of epidemiology in psychiatry at the Columbia University College of Physicians and Surgeons and is director of the Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute.